At least five players, including the Swasth Alliance, LiveHealth and DRiefcase, have built prototypes upon the National Health Stack APIs. This was revealed in a webinar held by Bangalore-based private think tank iSpirt Foundation on July 4.

LiveHealth is working on building API bridges to make health records from 1,500 labs accessible; DRiefcase has built a health locker for longitudinal health records; most importantly, the Swasth Alliance is working on the “Open Health Services Network” with iSpirt, along with a consent manager for their recently-launched teleconsult platform Swasth.app.

The National Cancer Grid (NCG) was the earliest adopter to implement parts of the health stack, notably a health data consent manager, which iSpirt demonstrated towards the end of May. The other players are Bajaj Finserv Health (from Bajaj Group) and iCliniq (an online consultation platform).

These six players “are the hero players because they are following this [the National Health Stack] approach”; they are “example setters”, iSpirt founder Sharad Sharma said. “The best example of that is Dr Pramesh from NCG; without his early embrace of this, this would not have made the progress that it has,” Sharma said.

Formed eight years ago, the NCG is a network of 220 private and public cancer centres spread across the country. Dr Pramesh CS, the grid’s convenor, said the centres together treat 7 lakh new cancer patients every year, bearing 60% of India’s cancer burden.

The NCG’s work around the National Health Stack was done witha lot of inputs and advisory role from iSpirt, but the implementation came through with Thoughtworks”, Dr Pramesh said. Along with the Thoughtworks team, they went on to implement the first version, iSpirt ‘volunteer’ Sidharth Shetty said. ThoughtWorks is a global software company, and is a technology partner for the Swasth Alliance and its teleconsult platform.

LiveHealth’s bridge to connect 1,500 labs

LiveHealth provides the lab information management systems (LIMS) for a majority of the labs in the organised sector. “They are early implementers of the API bridge that allows for labs to plug in and share patient health information,” Shetty said.

In the fist phase, it implemented the API bridge that offers the entire network of 1,500 labs to be accessible via one single bridge, which can then be accessed by any user / provider of health information, said co-founder Abhimanyu Bhosale. They built this not within the LiveHealth app, “as an independent entity” outside of it to be able to use it for third-party health information providers who are not LiveHealth customers. “By the time the product is ready [as per the below timeline], all 1,500 labs would registered and ready for use, and all LiveHealth customers will benefit. Then we will roll this out to third-party users.”

LiveHealth’s Abhimanyu Bhosale presents the company’s planned implementation timeline. Credit: iSpirt Foundation

Driefcase’s health locker, “standing consent”

DRiefcase has worked on a health locker, which lets the patient store their longitudinal health records. Unlike a consent manager flow, the patient will not be dependent on the healthcare provider to access their records. “The data can be accessed real-time, and does not need you to go through the consent mechanism each time,” co-founder Sohit Kapoor said.

  • Past records can also be uploaded to the health locker. At the same time, the user can access all their other health records with hospitals through the consent manager.
  • “It’s not just linking that happens, but you can get a copy and store your records on your health locker. The other thing here is an ongoing / standing consent that the health locker has, which is revocable by the user, which allows the locker to be regularly updated,” Kapoor said.

The Health locker acts like an health information provider, it works in a fairly standard manner. When the health information user requests for health data, and you will get the Health locker as one of the providers. “We will work on the modalities of whether the health locker takes precedence over other HIPs and vice-versa,” he said.

Swasth Alliance, working with iSpirt to create consent interfaces, peering between consent managers

The Swasth Alliance is already working on introducing a consent manager on the Swasth platform, along with a Swasth consent gateway, and the bridges that each health information provider and user will have to implement. This will be combined with other parts from the Stack. Their teleconsultation platform, which was first soft-launched in early May while riding on the success of Aarogya Setu, is now scaling up operations.

Ajit Narayanan, mFine CTO, but representing the Swasth Alliance, said that it wants to allow consults on Swasth from any healthcare provider, such as hospitals and health-tech companies. “Our goal was to seed the Open Health Services Network [OHSN] layer, working with iSpirt,” he said. “In some sense, you can say we are co-creating this with iSpirt in line with UPI and the general guidelines that have been laid out,” he said.

While we grow the OHSN layer to get more providers to adhere to a service specification, we are getting some players [within the Swasth Network] to implement the consent interfaces as well, enabling flows of health data. “We have already had a couple of discussions with the iSpirt team as well to nail that down. In the next 3-4 weeks, we will have data flowing between the multiple providers who are attached to the Swasth platform for teleconsultation,” Narayanan said.

As a further extension, “we are working with iSpirt team to build the inter-gateway peering protocol which will also be necessary”, he said. If you have data spread across multiple consent managers, then you’ll need some sort of peering protocol between the gateways to have seamless flow between any provider, he said.

Ajit Narayanan, Swasth Alliance presents. Credit: iSpirt Foundation

Swasth Alliance, formed just as telemedicine was legalised in India, has been instrumental is laying down the National Health Stack, essentially a set of APIs that will enable data flows for health, among other things. iSpirt, which has released the APIs, had said weeks ago that key members from the alliance had actively participated and given feedback on the Health Stack design. Teleconsults is a key use case of the Health Stack, and iSpirt founder Sharad Sharma has said that teleconsults is going to a focus area over the next few months. Both telemedicine and Aarogya Setu are part of the Health Stack, he had said.

It’s worth noting that iSpirt has not just released the APIs, but has laid down an overall roadmap and implementation for the Health Stack. From the beginning, it has talked about its vision for developing the Health Stack along the lines of UPI, which it evangelised. It has conducted presentations, demonstrated the first prototype and even advised on it, as Dr Pramesh pointed out above and laid down dates for test environments and certifications to go live.

Over the next week, it will release new standards based on feedback and implementation from different players. Certifications for the health data flow framework will go live on July 27 onwards, iSpirt repeated in this webinar. Questions, some of which we have flagged here, about the players and conflicts of interest remain.

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Read more of our coverage of the Health Stack:

  1. iSpirt demos a key part of Health Stack — the health data consent manager. Some questions. [read]
  2. The National Health Stack is shaping up: doctor registry in the works, test environments to go live on June 30 [read]